USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1960 > Part 51
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lif so specify WAR)
Mass
(If nonresident, give city or town and State)
Length of stay: In place of death
........... years.
.months ......
11 days. In place of residence ....
5
... years.
months.
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sent.
3
1960
(Month)
(Year)
4 1.
HEREBY CERTIFY
That I attended deceased from
19 60
....
Aug.23
19 ....
6000.
Sept. 3
I last few hetalive on
Sept 3,
1960., death is said to
have occurred on the date stated above, at 2:15 Am.
INTERVAL
BETWEEN
ONSET AND
(a)
DEATH
11 days
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Morris Hendricks
(Husband's name in full)
II IF STILLBORN, enter that fact here.
12
AGE
61
Years. Months Days
If under 24 hours
Hours.
.. Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
at home
15 Social Security No.
NONE
16 BIRTHPLACE (City)
(State or country)
....... New York City, N.Y.
17 NAME OF
FATHER
Isaac Kirschbaum
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Russia
19 MAIDEN NAME
OF MOTHER
Sarah-Cannot be learned
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
6 Beth David
Coston Elmont, L.
(City or Town)
Place of Burial or Cremation
DATE OF BURIAL
September 6, 19.60
7 NAME OF FUNERAL DIRECTOR Benjamin Birnbach
ADDRESS 10 Washington St Dorchester SEP 1 1959
Received and filed
Charles 4 Mackie
....
(Registrar)
PARENTS
5 Was disease or injury in any way related to occupation of deceased? No If so, specify
....... .............
(Signed) arnold & Kroll M. D. Arnold J. KRoll, M.D PRINT OR TYPE SIGNATURE) (Address) 330 Brookline Ave Date
Sept3 1960
Morris Hendricks
Informant
(Address)
5 Wave Way Ave Winthrop
I_HEREBY CERTIFY that/a satisfactory stardard certificate of death Cwas fled with me PEFORE the burial of transit permit was issued:
(Signature of Agent of Board of Health or other)
A11098 Seit 3, 1460
(Official Designation)
(Date of Issue of Permit)
X
ORM R-301A 1
INSTRUCTIONS FOR DICAL CERTIFICATE
In giving USE OF DEATH do not enter more than one cause for each (a), (b) and (c)
his daes mat mean mode of dying. as heart failure, enia, etc. It means disease, or compli- ons which caused
430
onditions, if any, hich gave rise to bove cause (a). ating the under. ing cause last.
Conditions contrib- g to death but not ted to the terminal ase condition given ®).
ote :- Chapter 137, 1 of 1954, requires sicians to print or the cause or es of death on h certificates, and oter 48. Acts of , requires Physi- 1 to print or type : under signature.
OV 30 1960
M-11-59-926662
(a) Residence. No. (Usual place of abode)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
5 Waveway Ave., Winthrop
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED Married
or DIVORCED
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Myocardial Infantion
Due To
coronary occlusion
(b)
Due To (e)
OTHER
SIGNIFICANT
CONDITIONS
Shock
Was autopsy performed ?
No
What test confirmed diagnosis ?
EKG
30 min
No. ....
Hendricks, Dora 2 FULL NAME
No
A TROL COPY ATANT!
Charles it. mackie City Registrar
TO!
i?
LERKY
4
6
NOV 301960 AM
X
PLACE OF DEATH
SUFFOLK (County) ROXBURY (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD
SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
233
OUT - OF - TOWN To be filed for burial permit with Board of Health or its Agent.
Na VENIVA MEMORIAL HOSPITALI
2 FULL NAME
PAULINE SWETT
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 50 MOORE Street, HOORE ST. WINTHROP
Mass.
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death .............. years ..
.... months ..
24 Days. In place of residence.
.years ...
......... months ..
............ days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF SEPTEMBER 3 1960
DEATH
(Month)
(Day)
(Year)
4 I HEREBY CERTIF Y That I attended deceased from 19 6 8 - ..... 8- , 19.GO,
I last saw hivalive on 9 .. , 19.60 death is said to have occurred on the date stated above, at 12:20Am.
DEATH WAS CAUSED BY : IMMEDIATE CAUSE (a) CARCINOMA OF DESCENDING COLON WITH METASTASES
Due To (b)
Due To (e)
OTHER SIGNIFICANT DIABETES MELLITUS CONDITIONS
YEAR
Was autopsy performed?
YES
What test confirmed diagnosis ? CLINICAL, AUTOPSY
5 Was disease or injury in any way related to occupation of deceased ? NO If so, specify
Sie Ramme Harrel M. D.
(Address
David Vicur Choul'm (Lebanon . ROXBURY 6
Placeof Burial or Cremation DATE OF BURIAL
(City or Town) September L 1960
7 NAME OF FUNERAL DIRECTOR Benjamin F.Solomon
ADDRESS 120 Harvard Street , Brookline.
Received and filed SEP 2, 1050 .....
(Registrar)
PARENTS
18 BIRTHPLACE OF FATHER (City) (State or country) Russia
19 MAIDEN NAME
OF MOTHER
Esther
(unknown)
20 BIRTHPLACE OF MOTHER (City) (State or country)
Russia
Florence Basch
21 Informant (Address) 36 Qunobequin Road, Waban, Mass.
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
po
(Signature of Agent, of Board of Health or other)
A11088
September 3.1960
1 (Official Designation)
(Date of Issue of Permit)
RM R-30IA 1
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving SE OF DEATH do not enter nore than one auae for each (a). (b) and (e)
is does not mean mode of dying, as heart failure. nia, etc. It means disease, or compli- which .
caused -
153.2
nditions, if any, ich gave rise ta ove cause (a), ting the under- camse last.
Conditions contrib- to death but not d to the terminal se condition given ).
te :. Chapter 137. of 1954, requires icians to print or the cause or s of death on certificates, and ter 48, Acts of requires Physi- to print or type under signature.
OV 30 1960
W-11-59-926662 1
Oa If married, widowed, or divorced HUSBAND of (Give maiden name of wife in full)
(or) WIFE of
Charles Swett
(Husband's name In full)
INTERVAL
BETWEEN
ONSET AND
11 IF STILLBORN, enter that fact here.
DEATH
12
AGE.82
LYEAR
Years
Months ..........
Days
If under 24 hours
.Hours ..........
„Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during n.ost of working life)
14 Industry
or Business :
Attime
15 Social Security No.
16 BIRTHPLACE (City) (State or country) Russia
17 NAME OF
FATHER
Jacob Elpert
SAMUEL HASSID (PRINT OR TYPE SIGNATURE) quis They Have Date 9-9-1960
8 SEX
female
9 COLOR
white
10 SINGLE
MARRIED
WIDOWED
or DIVORCEMarried
(write the word)
PHYSICIAN - IMPORTANT
f(Was deceased a
U. S. War Veteran,
{if so specify WAR)
.........
no.
give its NAME instead of street and number)
If death o
Registered No.
08904
A TRUE CONT AST LEY Charles it Mackie City Registrar
TO
OF
11 12. 1
GLERK
OFF
1
65
THROP M
NOV 3 01960 AM
X SUFFOLK (County) BRIGHTON (('ity or Town)
The Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD
OF - TOWN
234
To be filed for burial permit with Board of Health or its Agent.
Registered No. 1)886
[(If death occurred in a hospital or institution,
St. ( give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
((Was deceased a U. S. War Veteran, if so specify WAR)
(a) Residence. No. 91 WALDEMAR
(t'sual place of abode)
(If nonresident, give city of town and State)
Length of stay : In place of death ... .
years
months
3
days. In place of residence ........... years
month«
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
J DATE OF SEPTEMBER
5
1960
DEATH
fYear)
(Month) (Day)
1
HEREBY
CERTIFY.
That I attendedy deceased from
......
9/2
19.
60
to.
9/5
160
I last saw hof Rative on
9/5
1950, death in said to
have occurred on the date stated above, at 11:15 Am.
INTERVAL
BETWEEN
ONSET AND
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CORONARY Thrombosis E POSTERIOR MYOCARDIAL INFARCT
DEATH
3DAS
Due To (b) ...
Due To (c) ....
OTHER SIGNIFICANT CEREBRAL EMPOLVS CONDITIONS
3 DAYS
Was autopsy performed ?
...........
YES
What test confirmed diagnosis?
5 Wan disease or injury in any way related to occupation of deceased No If so, specify
(Signed)
Martini J. Melia
M. D.
MARTIN J. MELIA M.D.
(Address) St. Elizabeths Date ... 9/5 1960
6 St .Michael Cemetery ...... Boston (City or Town) Place of Burial or Cremation DATE OF BURIAL Sept 8 19
.60
7 NAME OF
FUNERAL DIRECTOR Ernest C. Caggiano ADDRESS 147 Winthrop St., Winthrop
SEP 8 NOV 19.
Received and filed
Charles 4 Jahre
A SEX
F
9 COLOR
White
10 SINGLE
(write the word)
WIDOWED> Widow
or DIVORCED
j
5
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
Salvatore Lazzara
( Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE 81
Years
2
Months
14
... Days
If under 24 hours
Hours ............
.. Minutes
13 Usual
Occupation :
Stitcher (retired)
14 Industry
or Business:
.....
Garment
15 Social Security No.
011-03-6234
16 BIRTHPLACE (City)
(State of country)
Italy
17 NAME OF
FATHER
Angelo Pardo
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Maria Nicosia
20 BIRTHPLACE OF MOTHER (City) (State or country) Italy
21 Informant
Mrs ....... Mary Rinella
(Address) 9] Waldemar Ave, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death us fled with me BEFOREthe barial or transit permit was issued: Elwas all Collauan pr (Signature of Agent of Board of Health or other)
A11183
Sept 6, 1960
(Official Designation) (Date q Issue of Permit)
X
M R-301A 1
STRUCTIONS FOR IL CERTIFICATE
n giving OF DEATH not enter e than one ae for each , (b) and (e)
does not mean ode of dying, I heart failure. . etc. It means ase, or compli- which caused
tions, if any, gave rise to cause (a). & the under. cause last.
ditions contrib- o death but not to the terminal condition given
:- Chapter 137, 1954. requirea ians to print or the cause or of death on ertificates, and r 48. Acts of equires Physi- o print or type nder signature.
OV 30 1960
1-6-59-925686
PLACE OF DEATH
2 FULL NAME
No. FilipPA (PARA
(If deceased is a married, widowed or divvied woman, give also maiden name.)
LAZZARA
CERTIFICATE OF DEATH
Si. Elizabeth's Hospital
AVENUE
St.
WINTHROP, MASS.
·
(Kind of work done during most of working life)
PARENTS
(PRINT OR TYPE SIGNATURE)
420.1
A TRUE COPY ATTEST:
Criarles it Mackie City Registrar
RECEIVED
TOW
?. 1
...
ER:
HIROPM
NOV 301960 AM
X
PLACE OF DEATH
Suffolk (County)
Bration
(City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
Registered No.
08940
S(If death occurred in a hospital or institution,
St. } give its NAME instead of street and number)
2 FULL NAME
Augustus Christopher
(If deceased is a married, widowed or divorced woman, give also maiden naine.)
(a) Residence. No.
46 Main Street, Winthrop, Lass
(Usual place of abode)
Length of stay : In place of death .............. years ....
... months.
21
.days. In place of residence 8
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Male
9 COLOR
white
10 SINGLE
(write the word)
MARRIED married
WIDOWED
of DIVORCED
10a If married, widelyher
sedine
Arno
(Give maiden name of wife ir. full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
44
12
AGE ..........
......
Years ........
.. Months .....
Days
If under 24 hours
.. Hours .............. Minutes
13 Usual
Occupation :
Cab Driver
(Kind of work done during most of working life)
14 Industry
or Business :
Town Cab Co.
15 Social Security No.
unknown
16 BIRTIIPLACE (City)
(State or country)
Boston
17 NAME OF FATHER
Americo Christopher
18 BIRTHPLACE OF
FATHER (City)
....
(State or country)
Italy
19 MAIDEN NAME
M. 1).
OF MOTHER
Ursula Pastore
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
6
St Michaels
Boston
Place of Burial or Cremation DATE OF BURIAL
Sept .....
(Gty or Town)
7 NAME OF
FUNERAL INRECTOR
ADDRESS
Anthony P. Rapino 9 Chevser st &B
Received and filed
19.
Plank & Značku
(Official Designation)
(Date of Issue of Permit)
.
X
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
September 7, 1960
DEATH
.(Month)
(Day)
(Year)
4.1 HEREBY CERTIFY.
August 17,
to September
That I attended deceased icom
60
HUSBAND of
19.
I last saw
hlalalive on
September 7, 19 00
death is said to
have occurred on the date stated above, at
5:30 AM
DEATH WAS CAUSED BY: IMMEDIATE CAUSE (a) ...... PNEUMONIA
Due To (b)
Due To (c)
OTHER
Richt PARietAl
BRAIN
CONDITIONS
TUMOR
11 Months
Was autopsy performed ?
NO
What test confirmed diagnosis ?
X-RAY, Culture
5 Was disease or injury in any way related to occupation of deceased ? //@ ... If so, specify
(Signed)
GARRETT G. Gillespie & M.M. (PRINT OR TYPE SIGNATURE)
(Address) NECENTER Hosp Date.
9/7/600
PARENTS
Catherine Christopher
21
Informant
(Address)
16 wiren St. winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed, with me BEFORE the burjal or, transit permit was Issued: Patricia a. Varglampe (Signature of Agent of Board of Healthof other) 968 8 9-8-60
235-
To be filed for burial permit with Board of Health or its Agent
....
No.
New England Centre Hospital
OUT - OF - TOWN
RM R-301A 1
--
INSTRUCTIONS FOR ICAL CERTIFICATE
In giving ISE OF DEATH do not enter more than one ause for each (a). (b) and (c)
is does not mean mode of dying, as heart failure, nia, etc. It means disease, or compli- which caused
93
nditions, if any, ich gave rise to ove cause (a), ting the under. mg cause last.
Conditions contrib- to death but not ed to the terminal se condition given ).
e :- Chapter 137, of 1954. requires cians to print or the cause or s of death on certificates, and er 48. Acts of requires Physl- to print or type tunder signature.
10V 30 1960
5-11-59-926662
PHYSICIAN - IMPORTANT (Was deceased a U. S. War Veteran. No (if so specify WAR)
.St.
(If nonresident, give city or town and State)
.. years .............. months .............. days.
Die
INTERVAL BETWEEN ONSET AND DEATH 10 days
SIGNIFICANT
A TRUE COPY ATT ST: Inarles it. mackie City Registrar
RECEIVED
TO!
OF
12
OFF!
CLERK
"5
HROP MARS
NOV 301960 AM
FORM R-303 A I
OR TYPE THE CAUSE OR CAUSES OF DEATH ON DEATH CERTIFICATES.
OV 30 1960
PLACE OF DEATH
Suffolk (County)
Boston
..... (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS MEDICAL EXAMINER'S CERTIFICATE OF DEATH
236
OUT - OF - TOWN
To be filed for burial permit with Board 110022
Registered No.
No. Massachusetts General ... Hospital .....
[(If death occurred in a hospital or institution,
St. [ give its NAME instead of street and number)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
( Was deceased a
U. S. War Veteran,
if so specify WAR) /Corean.
St
Winthrop,
Mass
(If nonresident, give city or town and State)
Length of stay : In place of death.
.. years ............. months .............. days. In place of residence.
1
.... years .............. months .............. days.
PERSONAL AND STATISTICAL PARTICULARS
9 SEX
10 COLOR
White
11 SINGLE
MARRIED)
WIDOWED
or DIVORCED
Married
HUSBAND of
Patricia Mc Collom
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
12 IF STILLBORN, enter that fact here.
13
AGE 41
Years
Months ..
.. Days
If under 24 hours
Hours
Minutes
14 Usual
Occupation :
Mechanic
( Kind of work done during most of working life)
15 Industry
or Business:
Wiggins Airlines
16 Social Security No.
Boston
17 BIRTHPLACE . (City)
(State of country)
Mass
18 NAME OF
FATIIER
Daniel Cash
19 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
20 MAIDEN NAME
OF MOTHER
Margaret Mac Donald
21 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
22
Patricia Cash
Informant
(Address)
35 Charles St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death
way filed with me BEFORE the burial or wansit permit was issued:
David M. Van Nostrand se
(Signature of Agent of Board of Health of other)
A-11282
9-11-60
(Official Designation) (Date of Issue of Permit)
X
2 FULL NAME
CALLON
CASH
(a) Residence. No.
35 ..... Charles ..... Street
(Usual place of abode)
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
September
8
1960
(Year)
(Month)
(Day)
4I HEREBY CERTIFY that I have investigated the death
of the person above-named and that the CAUSE AND MANNER thereof
are as follows : (If an injury was involved, state fully.)
Blunt ...... injuryof head with fracture
of skull, cerebral contusion and
laceration& ... subdural ..... hematoma ..
5 Accident, suicide, or homicide (specify )
Presumably
accidental
Date and hour of injury .
9/5/6.0
19
IF ACCIDENTAL, was injury causally related to the death?
Yes
Where did
Revere, Mass
Manner
Presumably in accidental fall
Injury
Injury
While at work ?
.. Was autopsy performed ?
Yes
6 Was disease or injury in any way related to recupation of deceased?
(Signed ..
Schall Trongo
. D.
Michael A Luongo, M. D.,
Print or Type Signature)
(Address) ...... Boston. ..... Ma.s.
Date ....
9.1.9
19.60
Winthrop Cemetery Winthrop
7
....
If deceased was a U. S. War Veteran, G.L. Chap. 36, Section 10, requires physicians to insert a recital to that effect.
SÅ 44-48.
of Death. See reverse side for additional information. See also Chap. 38, 55 6, 20; Chap. 46, 55 9, 10; Chap. 114,
DEATH In plain terms, so that it may be properly classified under the International Classification of Causes
Injury occur ?
(City or town and State)
Did injury occur in or about home, on farm, in industrial place, or in
public place ?
(Specify type of place)
N. B .- WRITE PLAINLY, WITH UNFADING BLACK INK-THIS IS A PERMANENT RECORD. Every item of Nature of
35M-11-59-926662
Place of Burial, or Cremation.
Sept 12
9.60
DATE OF BURIAL
.........
(City or Town)
8 NAME OF
FUNERAL DIRECTOR
arthur J0 miles
ADDRESS
. . +
Received and filed
Charles H. Zacker
(Registrar)
PARENTS
Information should be carefully supplied. MEDICAL EXAMINERS should state CAUSE AND MANNER OF (How did injury occur?)
(write the word)
Male
A TRUE COPY ATTEST:
Charles it Mackie
City Distrar
RECEIVED
TO:
OF
11 12 1
OFF/
1.
CLERK
5
35
THROP
NOV 3 01960 AM
X
PLACE OF DEATH
Suffolk
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS COPY OF CERTIFICATE OF DEATH
237
Chelsea
(City or Town making this return)
1
Chelsea
( City or Town)
No.
Soldiers' Home Hospital
.St.
§ (If death occurred in a hospital or institution,
¿ give its NAME instead of street and number)
2 FULL NAME
Andrew AnthonyLarorio
( Was deceased a
WWI
(If deceased is a married, widowed or divorced woman, give also maiden name.)
U. S. War Veteran.
if so specify WAR,
(a) Residence. No.
172 Somerset Ava
1
Winthrop, Mass
( Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death.
........ years.
.. months.
62
... days. In place of residence.
Fears.
........ months .......... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
Sept. 8,1960
( Month)
(Day)
( Year)
8 SEX
Male
9 COLOR
White
10 SINGLE
MARRIED
WIDOWED
or DIVORCED
Married
4 I HEREBY CERTIFY,
That I attended deceased from
July 8
60
Sept.8
19 to ..
19
60
I last saw
Sept .8
60
death is said to
have occurred on the date stated above, at
3:100
.. m.
(or) WIFE of.
( Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Acute myocardial Infarction hrs
Due Coronary artery thrombosis
hrs
13 Usual
Occupation:
Pressman
(Kind of work done during most of working life)
14 Industry
or Business :
Newspaper
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Boston, Mass.
OTHER
Diabetes mellitus.
SIGNIFICANT
CONDITIONS
Gangrene left toes
yes
Was autopsy performed?
What test confirmed diagnosis ?
autopsy
5 Was disease or injury in any way related to occupation of deceased ? If so, specify
(Signed )
Ned Better
Soldiers ' Home
M. D.
(Address )
Date
9/8/60
19
Winthrop Cem., " throp, Mass. 6
Place of Burial or Cremation
Sopt. 12,1900
wn)
DATE OF BURIAL 19
Porcella Fun.Home
ADDRESS
Received and filed 11-23060
(Registrar of City or Town where deceased resided )
. PARENTS
17 NAME OF
FATHER
Joseph
18 BIRTHPLACE OF
FATHER (City)
(State or country )
Italy
19 MAIDEN NAME
OF MOTHERTheresa Zager
20 BIRTHPLACE OF
MOTHER (City)
(State or country ) Boston, Mass.
21
Informant
Soldiers! Home Medical
(Address Records, Chelsea, Mass,
A TRUE COPY Yourph G. Tyrrell.
ATTEST :
(Registrar of City or Town where death occurred)
DATE FILED
Sept .9,1960
19
1 .. V
WRITE PLAINLY, WITH UNFADING BLACK INK OR USE APPROVED BLACK TYPEWRITER RIBBON - THIS IS A PERMANENT RECORD
· Copies of returns of deaths which occurred in your city or town in case the deceased resided in another city or town resided as soon as possible, after the close of the month in which the death occurred. (See Chap. 46, Sec. 12. G. L.) at the time of death should be transmitted on Form R-302 to the clerk of the city or town in which the deceased
50M-9-59-926111
( County)
75NÝ
Registered No.
487
( write the word)
10a If married, widowed, or
F.
Pozzuoli
HUSBAND of
(Give maiden name of wife in full)
INTERVAL BETWEEN ONSET AND DEATH
11 IF STILLBORN, enter that fact here.
12 63
4
13
AGE.
Years .....
Months .......
Days
If under 24 hours
Hours ........ Minutes
(b)
Due To
Arteriosclerosis
(c)
yrs.
7 NAME OF FUNERAL DIRE 10 No. Dennett St. , Boston,
ORM R-302
RECEIVED
OF
TOW:
1
GLERK
5
6
HR
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE 4/23/18 NOV .2-31980-AH
DATE OF DISCHARGE 6/17/19
RANK, RATING
PFC
ORGANIZATION AND OUTFIT Ft.Sill Okla., School of Fire Det.
SERVICE NUMBER
364715
X PLACE OF DEATH
SUFFOLK (County)
BOSTON (City or Town)
The Commonwealth of Massachusetts)UT - OF - TOWN EDWARD J. CRONIN SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH Registered No.
To be filed for burlal permit with Board of Health 19151 Agent
No. . COPLEY HOSPITAL INC. A Catina
MARIE . BONCORE
(If deceased' is aharried, widowed or divorced woman, give also maiden name.)
(a) Residence. No. 39 Grover
(Usual place of abode)
(If nonresident, give city or town and State)
Length of stay: In place of death years
months 21 days. In place of residence . years months . days.
MEDICAL CERTIFICATE OF DEATH
3 DATE OF
DEATH
Sept. (SIonth)
13 (Day)
1960 (Year)
8 SEX
female
9 COLOR OR RACE
white
(write the word)
MARRIED widowed
WIDOWED
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of ... ..
(Give maiden name of wife in full)
(or) WIFE of
Angelo Boncore
(Husband's name in full)
11 IF STILLBORN. enter that fact here.
12 89 AGE Years
Months Days
If under 24 hours
Hours . . Minutes
13 Usual
Occupation:
(Kind of work done during most of working life)
14 Industry
or Business:
at home
15 Social Security No.
unknown
16 BIRTHPLACE (City) (State or country) Italy
17 NAME OF FATHER Philip DeBilio
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Italy
19 MAIDEN NAME
OF MOTHER
Grace (unknown)
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Italy
21 Informant Joseph Boncore (son) (Address)} Centennial Ave ., Revere
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: Kohut Leand 11/34
(Signature of Agentof Board of Health or other) 13,1160)
(Official Designation) (Date of Issue of Permit)
PARENTS
M. D. 1960
Woodlawn Cemetery
Everett (City or Town)
6 ... Place of Burial or Cremation
DATE OF BURIAL September 16, ,60
7 NAME OF
FUNERAL DIRECTOR
Vincent Kapino
ADDRESS 9. Chelsea St., East Boston, Mass.
Received and filed SEP 1 9 1960
Charles 4 Macke".
...
(Registrar)
PERSONAL AND STATISTICAL PARTICULARS
10 SINGLE
4 I HEREBY CERTIFY.
Aug. 23
1960
That I attended deceased from
...
to Sept. 13
19 60
I last saw her alive nn Sept. ... 13
19 60 death is said to have occurred on the date stated above. at 10 :20P. m.
INTERVAL BE. TWEEN ORSET AND DEATH
DISEASE OR CONDITION DIRECTLY LEAR GENERAL ARTERIOSCLEROSIS TO DEATH (a) WITH HEART DISEASE
YRS.
ANTE Due TMULTIPLE CEREBRAL CEDENT (b) CAUSES THROMBOSIS
irOS.
Due To (c)
OTHER SIGNIFICANT CONDITIONS
Major findings:
Of operations
Date of operation Was autopsy performed? MYRON ROSENTHAL M.D.
What test confirmed diagnosis?
5 Was disease or injury in any way related to occupation of deceased? NC. If so, specify (Signed) (Address)
Sumore of Date 9-13
50M-5-55-915023
FORM R-301A -
INSTRUCTIONS FOR MEDICAL CERTIFICATE In glving CAUSE OF DEATH do not enter more than one cause for each of (s), (b) and (c)
This does not mean he mode of dying. such s heart failure. asthewia, c. It means the disease, w complications which amsed death. $$20
Morbid conditions. fany, giving rise to the bore camse (a) stating ke underlying camse
Conditions contrib- ting to the death but not dated ta the disease or condition causing death.
Note :- Chapter 137. Acts of 1954, requires Physicians to print or ype the cause or causes of death on death certificates
NOV 30 1960
f(If death occurred in a hospital or institution.
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